How well do health professionals interpret diagnostic information?:A systematic review

OBJECTIVE: To evaluate whether clinicians differ in how they evaluate and interpret diagnostic test information. DESIGN: Systematic review. DATA SOURCES: MEDLINE, EMBASE and PsycINFO from inception to September 2013; bibliographies of retrieved studies, experts and citation search of key included studies. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Primary studies that provided information on the accuracy of any diagnostic test (eg, sensitivity, specificity, likelihood ratios) to health professionals and that reported outcomes relating to their understanding of information on or implications of test accuracy. RESULTS: We included 24 studies. 6 assessed ability to define accuracy metrics: health professionals were less likely to identify the correct definition of likelihood ratios than of sensitivity and specificity. –25 studies assessed Bayesian reasoning. Most assessed the influence of a positive test result on the probability of disease: they generally found health professionals’ estimation of post-test probability to be poor, with a tendency to overestimation. 3 studies found that approaches based on likelihood ratios resulted in more accurate estimates of post-test probability than approaches based on estimates of sensitivity and specificity alone, while 3 found less accurate estimates. 5 studies found that presenting natural frequencies rather than probabilities improved post-test probability estimation and speed of calculations. CONCLUSIONS: Commonly used measures of test accuracy are poorly understood by health professionals. Reporting test accuracy using natural frequencies and visual aids may facilitate improved understanding and better estimation of the post-test probability of disease

Confirmation of a Faraday Rotation Measure Anomaly in Cygnus

We confirm the reality of a reversal of the sign of the Faraday Rotation Measure in the Galactic plane in Cygnus (Lazio et al, 1990), possibly associated with the Cygnus OB1 association. The rotation measure changes by several hundred rad/m$^2$ over an angular scale of $2-5^{\circ}$. We show that a simple model of an expanding plasma shell with an enhanced density and magnetic field, consistent with observations of H$\alpha$ emission in this part of sky, and physically associated with a superbubble of the Cygnus OB1 association, can account for the magnitude and angular scale of this feature.Comment: Submitted to the Astrophysical Journa

A search for radio afterglows from gamma-ray bursts with the Australian Square Kilometre Array Pathfinder

We present a search for radio afterglows from long gamma-ray bursts using the Australian Square Kilometre Array Pathfinder (ASKAP). Our search used the Rapid ASKAP Continuum Survey, covering the entire celestial sphere south of declination $+41^\circ$, and three epochs of the Variables and Slow Transients Pilot Survey (Phase 1), covering $\sim 5,000$ square degrees per epoch. The observations we used from these surveys spanned a nine-month period from 2019 April 21 to 2020 January 11. We crossmatched radio sources found in these surveys with 779 well-localised (to $\leq 15''$) long gamma-ray bursts occurring after 2004 and determined whether the associations were more likely afterglow- or host-related through the analysis of optical images. In our search, we detected one radio afterglow candidate associated with GRB 171205A, a local low-luminosity gamma-ray burst with a supernova counterpart SN 2017iuk, in an ASKAP observation 511 days post-burst. We confirmed this detection with further observations of the radio afterglow using the Australia Telescope Compact Array at 859 days and 884 days post-burst. Combining this data with archival data from early-time radio observations, we showed the evolution of the radio spectral energy distribution alone could reveal clear signatures of a wind-like circumburst medium for the burst. Finally, we derived semi-analytical estimates for the microphysical shock parameters of the burst: electron power-law index $p = 2.84$, normalised wind-density parameter $A_* = 3$, fractional energy in electrons $\epsilon_{e} = 0.3$, and fractional energy in magnetic fields $\epsilon_{B} = 0.0002$.Comment: 18 pages, 7 figures; accepted for publication in MNRA

Comparison of microbiological diagnosis of urinary tract infection in young children by routine health service laboratories and a research laboratory: Diagnostic cohort study

OBJECTIVES: To compare the validity of diagnosis of urinary tract infection (UTI) through urine culture between samples processed in routine health service laboratories and those processed in a research laboratory. POPULATION AND METHODS: We conducted a prospective diagnostic cohort study in 4808 acutely ill children aged <5 years attending UK primary health care. UTI, defined as pure/predominant growth ≥105 CFU/mL of a uropathogen (the reference standard), was diagnosed at routine health service laboratories and a central research laboratory by culture of urine samples. We calculated areas under the receiver-operator curve (AUC) for UTI predicted by pre-specified symptoms, signs and dipstick test results (the "index test"), separately according to whether samples were obtained by clean catch or nappy (diaper) pads. RESULTS: 251 (5.2%) and 88 (1.8%) children were classified as UTI positive by health service and research laboratories respectively. Agreement between laboratories was moderate (kappa = 0.36; 95% confidence interval [CI] 0.29, 0.43), and better for clean catch (0.54; 0.45, 0.63) than nappy pad samples (0.20; 0.12, 0.28). In clean catch samples, the AUC was lower for health service laboratories (AUC = 0.75; 95% CI 0.69, 0.80) than the research laboratory (0.86; 0.79, 0.92). Values of AUC were lower in nappy pad samples (0.65 [0.61, 0.70] and 0.79 [0.70, 0.88] for health service and research laboratory positivity, respectively) than clean catch samples. CONCLUSIONS: The agreement of microbiological diagnosis of UTI comparing routine health service laboratories with a research laboratory was moderate for clean catch samples and poor for nappy pad samples and reliability is lower for nappy pad than for clean catch samples. Positive results from the research laboratory appear more likely to reflect real UTIs than those from routine health service laboratories, many of which (particularly from nappy pad samples) could be due to contamination. Health service laboratories should consider adopting procedures used in the research laboratory for paediatric urine samples. Primary care clinicians should try to obtain clean catch samples, even in very young children